Xu Jianwei, Li Chengqing, Wu Jiahao, Wang Pengrui, Liu Han, Li Feng, Wang Lei
Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China.
Surg Endosc. 2025 Jan;39(1):212-218. doi: 10.1007/s00464-024-11311-x. Epub 2024 Nov 4.
It is widely believed that the prerequisite for safely performing enucleation is that the distance between the tumor and the main pancreatic duct (MPD) is at least 2-3 mm. However, enucleating a deep pancreatic tumor adjacent to the MPD remains challenging, particularly when exposure or repair of the MPD is necessary. This study reported our initial experience with this procedure and demonstrated the feasibility and safety of the MPD exposure or repair.
Patients who underwent laparoscopic enucleation (LapEN) with exposing the MPD from January 2017 to August 2023 were collected and analyzed in this retrospective cohort study. Data from procedures of laparoscopic middle pancreatectomy (LMP) and LapEN for superficial tumors were collected for comparative analyses.
A total of 26 patients were enrolled, 27 tumors were enucleated. Tumor located in the pancreatic head and neck (n = 20), and the body (n = 7). The mean tumor size, operating time, and blood loss were 2.3 cm, 163 min, and 63 ml, respectively. MPD injuries occurred in 8 cases due to the need for complete tumor resection, which were repaired or reconstructed using 6-0 PDS-II with or not inserting a plastic stent. 10 cases (38.5%) developed surgical-related complications, seven (26.9%) were classified as Clavien-Dindo grade I, and three (11.5%) were Clavien-Dindo grade IIIa. Biochemical leakage occurred in 16 cases (61.5%), clinically relevant pancreatic fistula (CR-POPF) occurred in 10 cases (38.5%). Two patients (7.7%) experienced post-pancreatectomy hemorrhage. Further analyses indicated LapEN with MPD exposure had a longer operating time and higher incidence of CR-POPF compared to LapEN for superficial tumors, but a shorter operating time and less blood loss compared to LMP (P < 0.05).
Laparoscopic enucleation with exposing the MPD is feasible and safe with the support of precise preoperative assessments, meticulous intraoperative dissection, well familiarity with the anatomy of the MPD, and excellent surgical skills.
人们普遍认为，安全进行摘除术的前提是肿瘤与主胰管（MPD）之间的距离至少为2 - 3毫米。然而，摘除靠近MPD的深部胰腺肿瘤仍然具有挑战性，特别是在需要暴露或修复MPD时。本研究报告了我们在此手术中的初步经验，并证明了MPD暴露或修复的可行性和安全性。
在这项回顾性队列研究中，收集并分析了2017年1月至2023年8月期间接受腹腔镜摘除术（LapEN）并暴露MPD的患者。收集腹腔镜中段胰腺切除术（LMP）和LapEN治疗浅表肿瘤的手术数据进行比较分析。
共纳入26例患者，摘除27个肿瘤。肿瘤位于胰头和颈部（n = 20），以及胰体（n = 7）。平均肿瘤大小、手术时间和失血量分别为2.3厘米、163分钟和63毫升。由于需要完整切除肿瘤，8例发生MPD损伤，使用6-0 PDS-II进行修复或重建，有无插入塑料支架。10例（38.5%）发生手术相关并发症，7例（26.9%）为Clavien-Dindo I级，3例（11.5%）为Clavien-Dindo IIIa级。16例（61.5%）发生生化渗漏，10例（38.5%）发生临床相关胰瘘（CR-POPF）。2例患者（7.7%）发生胰腺切除术后出血。进一步分析表明，与LapEN治疗浅表肿瘤相比，暴露MPD的LapEN手术时间更长，CR-POPF发生率更高，但与LMP相比，手术时间更短，失血量更少（P < 0.05）。
在精确的术前评估、细致的术中解剖、对MPD解剖结构的充分熟悉和出色的手术技巧支持下，暴露MPD的腹腔镜摘除术是可行且安全的。
